St. John's Wort in the Treatment of Raynaud's Phenomenon
This trial will test the efficacy of St. John's Wort (SJW) as a supplement, in the treatment of Raynaud's phenomenon (RP). The investigators are hypothesizing that taking SJW 300mg, 3 times a day will decrease the frequency, duration, and severity of RP attacks when compared to placebo.
Patients with RP will answer questionnaires and self-evaluate their symptoms of RP as a baseline. Then they will be assigned to either a treatment (will receive SJW capsules) or placebo (will receive non-therapeutic capsules) group. They will be required to take their capsules, self-evaluate their progress and be evaluated every two weeks in a clinic. The treatment phase will last six weeks.
This trial will be conducted in a way to mimic the normal usage of natural products. Patients will not be required to stop any current treatment for RP.
|Study Design:||Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
|Official Title:||A Randomized, Placebo-controlled Trial of St.John's Wort(a Natural Health Product) in the Treatment on Raynaud's Phenomenon|
- Frequency of Raynaud's Phenomenon (RP) attacks [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
- Duration of RP attacks [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
- Severity of RP attacks [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
- Daily functions questionnaires (HAQ, SF-36, DASH) [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
- Biological markers of endothelial damage (V-CAM, I-CAM, VEGF, etc.) [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
|Study Start Date:||March 2007|
|Study Completion Date:||August 2008|
|Primary Completion Date:||August 2008 (Final data collection date for primary outcome measure)|
St. John's wort 300mg PO TID
Drug: St. John's Wort
SJW in capsule form 300 mg PO TID
Other Name: Webber natural brand, product number 5006.
Placebo Comparator: 2
Lactose in capsule matching the St. John's wort. 300mg PO TID
lactose in gelatin capsule that same as St. John's wort
Raynaud's Phenomenon (RP) is a common vasospastic problem of digital artery vessels causing pain and ischemic fingers (the fingers turn white and then blue and or red). It is considered primary when it is not associated with other conditions. Raynaud's symptoms that are associated with pathological underlying cause especially connective tissue diseases are defined as secondary Raynaud's and are usually more severe than primary symptoms. Selective Serotonin receptor inhibitors (SSRIs) have shown to be effective in decreasing the symptoms of RP.
St. John's Wort (SJW) is an natural product that is presently approved by Health Canada for treatment of depression. It is believed that SJW would have mechanism of action very similar to SSRIs.
This clinical trial will measure the efficiency of SJW in decreasing the frequency, duration and severity of RP attacks. SJW will be test as a supplement to other treatments already in place. 76 patients (38 with primary Raynaud's and half with secondary Raynaud's) will be recruited from the Rheumatology clinic of St. Joseph's Health Care in London, Ontario. The recruitment period will span 18 months. As they enter the trial, subjects will be assigned to a treatment or a placebo group according to a pre-set randomization schedule. This assignment will be stratified for primary or secondary Raynaud's and double-blinded (patient and investigator).
The primary outcome measure (frequency, duration and severity) will be assessed by the patient on a daily basis using a journal provided by the investigator. Secondary outcome measures will include functions questionnaires (HAQ, SF-36, DASH) and biological markers of endothelial damage (V-CAM, I-CAM, VEGF, von Willebrand factor), will be conducted as a baseline and at the conclusion of the treatment phase.
Patients participation will span 8-10 weeks. The first two weeks are a baseline measurement for the status of RP using the journals, questionnaires, and serum tests. The treatment period will last 6 weeks in which the subject will be taking the capsules that they have been assigned and will be evaluated for changes or side-effects every two weeks. At the last visit the questionnaires and serum test will be repeated.
Other results which may arise from the trial are:
- The safety of SJW in rheumatology patients, by monitoring side-effects
- The attitude of rheumatology patients in using Natural Health Products, by a questionnaire
- Elucidating parts of the RP mechanism, by measuring bio-markers
- Differences between primary and secondary RP, by stratified randomization
The results will be analyzed for all three primary outcome measures as a difference of between baseline and treatment. These differences will be compared between treatment and placebo and each will be stratified for primary vs. secondary and possibly other demographic data.
This trial, if positive, will offer another treatment to RP patients. This option will possibly have less side-effects and be better accepted because it is a Natural Product.
|Rheumatology Clinic, St. Joseph's Health Care|
|London, Ontario, Canada, N6A 4V2|
|Principal Investigator:||Janet E Pope, MD, MPH||Associate Professor of Medicine University of Western Ontario|